Cut & Paste always struck me as more of a Windows thing. Which is weird because obviously I can do cmd+X / cmd+V on a mac... I just never do. Instead it's "select" - command+C - delete - cmd+V.
Am I the only one who does that?
(EDIT: Same thing on Finder. cmd+C cmd+Del cmd+V)
Anyway, I love the design aesthetic of the site, and when people question existing paradigms. Will definitely be checking Ishmael out.
LinkedIn is one of the most annoying sites on the internet. Every time I mistakenly click a link, it automatically grabs my Google account and creates a new account and profile for me, which I then have to go in and delete. Yes, I finally figured out which arcane preferences settings across both LinkedIn and Google I had to tweak to stop this from happening, but I think it was only after ChatGPT was around to help me wade through the mess.
If you use Chrome, or many of its derivatives, you can log into the web browser itself, and many people don't even know they are doing so. It can leak a lot of data, more so if you use the 'sign in with…' feature on many web pages. On a phone, if you're logged into the phone OS you're logged into the included web browser, and an aftermarket web browser may still leak information from your phone login.
I don't log my phone OS or web browser into any accounts, so I don't have to worry about LinkedIn making fake profile pages, but Cloudflare pretty much always assumes I'm a bot, so there's a bit of a downside. Honestly, I'm probably better off not visiting most of the web pages it blocks me from.
This isn't LinkedIn specific - the easily misclickable "one click to logon with Google" button showing up in browsers was a huge mistake and should never have existed. Reddit has started prompting too if you're not currently logged in, to just suddenly be logged in with Google.
Yep, that happened to me too. The biggest joke was that LinkedIn forced me to create a password before I could delete the profile they'd created without my permission. This happened after I'd visited several LinkedIn links on my Pixel phone so they grabbed my Google email address and used that. Bear in mind also that I'd been retired for about six years at that point.
Yes, that is precisely what happened. Over and over again. Every time I had to delete it. It was something to do with the way they embedded Google login on the page.
I wrote a thing about exactly this, but I'm resistant to blogging for undefined reasons so, maybe this will help someone...
# AI speech is an Infohazard
Apart from all its other possible boons and ills, one danger of AI is just that it is useful, so you use it. A lot.
In earlier days I would dive deeply into an author's work and start to think and write like them for a while. It was a heady feeling: slinging sonnets like Shakespeare—not at his level, but stylistically reminiscent—or tweaking turns like Twain.
Like all things, the effect lasts in relation to how long and how much you do it. The point is: our thinking is influenced by what we take in. Take more of a certain thing in, think more like that thing.
Now enter AI. My hand-crafted coding days are in their twilight months ("AI years"), and most of my software engineering is done through jaggedly capable agentic power tools. Instead of working directly with raw codestuff, I work with slop prose flecked with code sprinkles.
I read orders of magnitude more AI-speak—I call it "babble", or perhaps "Babel"—than human-written text. I can feel its genuinely honest points, clearly stated, slipping their banal tendrils into my thoughts and inner monologue.
Solutions? For me:
1. Be aware. "I notice that my thought stream is under assault."
2. Read stuff far from slop. Even a small dose of the good stuff can help inoculate. Recently I thought On the Calculation of Volume was something completely different.
3. Write stuff that is different. This post. Force the mind to synthesize thoughts in other ways.
4. debabel.py / debabel.js: a tool, and a pi extension, which filters common babble from visible LLM output. A lint for mind-killing prose.
It is not perfect, but it 80/20s nicely. I am willing to accept mildly awkward prose to avoid polluting my own internal distributions.
Details and example in the first comment. Tool available upon request.
The tool uses good old-fashioned regex/NLP—no LLMs—and rewrites the visible LLM Markdown without touching files on disk. I made it by analysing 10M+ words of past pi transcripts, doing frequency and pattern analysis, and iterating on rules to strip out the most egregious sloperisms. Now the circle is complete.
BEFORE
"Honestly, you're absolutely right—and that's a great question. Let me be clear: the fact that the parser works at all is actually quite remarkable. We utilize the tokenizer in order to handle the majority of edge cases, and due to the fact that it's recursive, it processes a large number of inputs. It's worth noting that this isn't really a bug—it's genuinely a deliberate design choice. In terms of raw throughput, the cache is significantly faster, and I think we should simply ship it.
That said, at the end of the day, not only is the design correct, but it is also fast. In other words, prior to refactoring, we should clearly delve into the nuanced, robust architecture. In conclusion, this is a testament to the seamless, intricate work the team has done."
AFTER
"That's a great question. That the parser works at all is remarkable. We use the tokenizer to handle most edge cases, and because it's recursive, it processes many inputs. This is a deliberate design choice. For raw throughput, the cache is faster, and we should ship it.
Not only is the design correct, but it is also fast. Before refactoring, we should delve into the nuanced, robust architecture. This is a testament to the seamless, intricate work the team has done."
("It consists in gumming together long strips of words which have already been set in order by someone else, and making the results presentable by sheer humbug" -- Orwell predicts the LLM)
and also https://www.jstor.org/stable/25515288 "The Myles na gCopaleen Catechism of Cliché" itself is rather hard to find online, but he's a very funny writer so it's worth the effort.
AI + hardware has really helped my wife and I get more sleep.
I had an esp32-box-3 lying around from a lapsed "voice agent" project from a year or two ago. Had a baby. Baby moved to another room, sleep trained. Baby either: 1. wakes up a few times a night, babbles for a bit, goes back to sleep OR 2. baby wakes up and fusses for N (=10) minutes, at which point parents need to go in and settle (that's the sleep training routine we use).
In either case, we do NOT want to wake up every time the baby does. Baby can go back to sleep easily, we adults have a harder time. A few rounds with Claude and the esp32 is now our new baby monitor. It tracks cry/fuss duration and publishes an audio stream (via a web UI or direct with, say, VLC). The audio only comes through AFTER N minutes of fussing have elapsed. It also posts notifications (to ntfy) after 30s and N minutes. My log says baby often wakes up 1-2 times a night and resettles almost immediately. We only wake up if the audio comes through, after N (10) minutes.
Also during the day it's really handy to be notified when baby has woken up from her nap. Let's us be out of the house, or in a distant room, and still keep track of what's going on.
It's fun to keep improving and adding features to this. Never would have had the time/energy to get this done without a coding agent. I ordered a set of 10 more of the esp32-box-3s to give them out to my friends (well, some are for other projects... so much potential).
(EDIT: Yes, I know this isn't AI designing hardware, but even writing code for embedded off the shelf stuff feels like a huge new potential.)
This is one of the killer use cases of AI, build personalized stuff for your life, that no company does. It is kind of generalized „intelligent stuff“ that one can use. Like minecraft your life
Baby monitors fundamentally need to be safe and allow parents peace of mind. Knowing they can constantly hear the baby and communicate verbally to soothe, as if you were in the room with them, allows this. It already means you only have to respond and/or get up to tend if they are still unsettled after a period of time. Monitors also have volume control so you can stay alert without being constantly disturbed.
The traditional baby monitor system had three states (ON and functional, ON and non-functional, OFF). It provides a constantly available and instantaneous test for "functional" - as long as you can hear sound from the other unit, it's almost guaranteed to currently be in a safe condition. Monitoring is constant, human-first, and all human. The system is relatively fail-safe.
Your design replaces this with a multi-state system and algorithms (adding ON in listening mode, ON in delay mode with output off, ON and partially-functional etc.). It removes any reliable method to prove an obviously "functional" state at any given time. Monitoring is non-constant (for the human), machine-first, and human as last resort (like corporate customer services). The system is not fail-safe despite being machine-first and at higher risk of error or malfunction due to complexity.
The risks include a few failed notifications or incorrect delay timing leading to early developmental trauma, such as fear of abandonment. It doesn't take much. We are still learning to deal with this human-human, before adding invisible unknowns.
If nothing else, what are babies likely to learn in a pre-verbal state where the days are spent sensing and observing their environment to develop the brain? It'll probably be how to game the baby monitor algorithm.
> Also during the day it's really handy to be notified when baby has woken up from her nap. Let's us be out of the house, or in a distant room, and still keep track of what's going on.
If you are going out of earshot of the baby by doing this, you are fully relying on the technology being functional. That would seem unnecessarily risky, and not nice for the baby (they can sense this stuff). The odds of a catastrophe are low in a singular environment, but still enough to worry. Almost inevitably it would end badly if this were scaled to a mass consumer product.
The idea is interesting from an engineering view, but from a human one it feels dystopian to insert a machine between parent and baby to this extent. It removes/replaces a layer of human-human connection. Where does engineering the natural human experience out of life end? Automated feeding? AI nannies and teachers? Then onto AI therapist?
My suggestion would be to do a lighter version of the features in a system which focuses on safety (always being able to monitor no matter what, for example on the ESP32, you could have the second core independent and direct-output the feed if the first core hangs or crashes). Feature-wise, rather than not alerting for 10 minutes, you could apply a DSP algorithm which reduces harsh frequencies for this period, whilst slowly increasing the output volume of the monitor.
I like the idea of alerts because it expands the base features without risk, and crucially makes the babies life better, as alerts could be sooner for important things that do need attention quickly. As an experiment, you could add an SD card and record snippets of cries which ended up in alerts, tag them with an ordered list of what you did to soothe or what was wrong, and see if AI can make anything of the data. Maybe certain cries can trigger alerts sooner, or cries over an extended period may indicate fever.
Thank you for engaging with this thoughtfully. You've highlighted the HUGE difference between "bespoke just for me/us" and "product that works for everyone". I've been struggling with this myself, since its value to my family is such that I immediately think "how can I share/sell this to everyone?"
In my case, I have a separate heartbeat check process (running on another machine) which ensures that the monitor is correctly working (no silent fails). I also wired up a SECOND esp32-box-3 as a receiver, and it will complain loudly if the transmitter one isn't sending (much like most normal baby monitors do). The monitor (web ui) has an option of directly listening to the raw non-gated audio, which I use every now and then to confirm what's going on. I also record the streams sometimes for algorithmic improvement.
My aim is not to replace human connection with machines, it's to allow the parents a bit more sanity so as to be better carers for our children. So far we've gained in sleep, piece of mind, and reduced stress. The last one is important - listening to your baby yell for 10 minutes, even if you know they're just annoyed because they don't want to sleep, can be really draining (especially for mom). The notifications allow us to keep tabs on things without the direct audio line to the limbic system.
Pi is my daily driver. I noticed the same phenomenon, and had Claude analyze all my past transcripts for classes of 'edit' error. Built an extension which patches the edit tool to self-heal on the majority of those kinds of calls. It's not 100%, but it cuts down on the rejections quite a bit and saves a few round trips.
EDIT: It's still quite fascinating seeing the kinds of things the models keep trying to do. It almost seems like when a human has slightly off with their nervous system. The conscious brain wants to do one thing, but for some reason the signals aren't getting to the hands correctly.
I've always wondered what "illegal" means in this context? Is it designed to just be a pejorative, or something incendiary? When is an invasion "legal"? I can't really think of any case where any kind of recognized body of law (especially one that both constituents would recognize) would impose legality on an invasion, so it seems that people say "illegal" in much the same way that "legal" has become a stand-in in our society for "moral".
Should I read it as "immoral invasion"? Leaving aside whether it is or isn't, at least that framing makes sense, because you can meaningfully debate the morality of an invasion, but I can't understand how you could debate legality (except perhaps within the country's own internal framework of laws, like if a president declared a war without going through the proper legal channels).
An invasion can be legal when authorized by the UNSC due to some crisis or when it's done in self-defence or to defend some other country.
So examples of some illegal invasions: US invasion of Iraq, Russian invasion of Ukraine. Legal invasions (although illegalities were found afterwards, but much of the invasion was legal) are the invasion of Libya, probably the NATO invasion of Serbia depending on what actually happened (there are still some open questions-- it matters why people went in).
Reasons to think the Israeli invasion of Lebanon is illegal are the mass-bulldosing of civilian buildings, destruction of farmland, some opinion articles about Lebanese territory being legitimately Israeli territory and an appropriate target for settlement etc. It shows a plan that is not primarily about self-defence.
If you’re in gmail there’s literally already an interface to easily unsubscribe from stuff, it’s under “Manage subscriptions”. Yahoo similarly have a “subscriptions hub”
This interaction was a delightful example of life in 2026 - the disparity between what AI can do, and what and how we use AI. (Which I like to term for myself "Phenomenal cosmic powers!... Itty bitty living space.")
Really lovely article. In paramedicine we usually treat 10g of acetaminophen in a 24-hour window as a potentially fatal overdose. That's also why the law in Australia was changed to require acetaminophen to come in blister packs (harder to get each pill out) of no more than 16. At 500 mg, that only gets you up to 8 g if you eat the whole thing, which is still hopefully non-fatal.
I always thought a simple over-the-counter supplement (NAC) being the cure for an overdose was so cool. It's a pretty cool substance in a lot of ways, and this is a great spur to myself to research it more thoroughly.
I randomly bought NAC just to try it. I dont know about the chemical interactions, but going out with collegues at that time taught me that it's basically impossible to get drunk. Usually a pint of beer is enough to make le feel at least a little dizzy, but when taking NAC, it was all like drinking water
If you all think NAC is great, wait till you try liposomal glutathione (glutathione is one of the things NAC is a precursor for, one of the general take-out-the-trash compounds for your cells). Of all the supplements I’ve tried, it has probably the most immediately noticeable positive effect (maybe because you take it by leaving it under your tongue to be absorbed sublingually for a bit before swallowing). Generally leaves me feeling great, even if I was kind of dragging and tired beforehand.
When I go out drinking with my pharmacist buddy, we take NAC before going out. He swears it makes hangovers less likely. I can't say I've noticed that particular effect, but I do seem to sleep a bit better on those nights.
> Apparently for some people it also helps with lessening tolerance for their ADHD meds, but I'm not so sure about that.
I'd believe it. I first heard of NAC on the nootropic subreddit in a past lifetime. The benefits vary, but generally it's a safe thing with a low chance of making anything worse, but a possibility to improve things. Many neurodivergent folk have written about how they benefit.
I'd give more info on the exact benefits they found (iirc OCD and rumination loops could be broken more easily), but unfortunately my memory is failing me.
My anecdotal experience is that NAC makes me much more tolerant to alcohol. As in, I can drink a lot more without feeling the effects. Since I don't get the same buzz, I care less about reaching for a beer.
How is nac (acetylcysteine) delivered there? I can buy dissolvable tablets here in Europe but from what I see that’s less helpful for mucous, things like mucomyst require inhalation, which isn’t in otc products I know of.
In the Philippines it's available as an effervescent tablet to be dissolved in water. They still tend to work better than the western remedies (guaifenesin etc) even in this form IME.
Usually here in Canada it's available in capsule form which I find less effective.
Same here actually, I find it slightly helpful but the effect’s useful time is limited. I’ve wondered if I could capture the gas released while bubbling and inhale that…
The dissolvable tablets completely fix a runny nose for me. Much better than any nose spray, which tend to irritate the nose and lead to chronic runny nose if taken for too long.
I've heard it suggested that acetaminophen just come with a small dose of NAC alongside it to make it safer. I guess this would require a lot of regulatory work to approve, but given that 500 people a year OD, it seems like a thing we should at least consider.
Meanwhile, it's funny that it seems like acetaminophen should safer in more scenarios, but the other has a lot of overdoses with typical use, I guess that's why there's a gap between the two, because ODs are apparently a lot more common or at least more legible than problems caused by the other drug.
Certain esters have been found to be much safer (in mice, at least):
> The glutathione hepatic values in mice obtained by intraperitoneal injection of the ester are superimposable on controls and the oral LD50 was found to be greater than 2000 mg kg^-1 and the intraperitoneal LD50 was 1900 mg kg^-1 ...
and more general analogs apparently can also be designed to not produce NAPQI:
> Thus, in 2020, N-sulpharyl-APAP prodrugs 39–40
(Fig. 11) were developed. [...] They are not hepatotoxic because they do not generate toxic metabolite NAPQI, even in concentrations equal to a toxic dose of APAP (600 mg kg^−1 in mice).
I am blessed with living in one of the most polluted areas in the world (PM2.5 going into thousands of µg/m³ in winter; summers are not much better due to dense chemical smog). Can you say more about how you're using it to combat that? Thanks!
What does ingesting 10g of acetaminophen even look like? I've got to imagine the fatal dose is far, far, far lower with chronic usage. Finding out that people are ingesting grams is profoundly disturbing.
I have taken 4-5g in a day while suffering from intense pain before.
There is a limit to the amount of opioids they will prescribe you, even if you are in mind shattering pain. For instance while attempting to get your dental insurance to actually cover a treatment you may find yourself between risking organ damage or risking $5000+ in ER visit bills only to have them refuse to give you anything but Tramadol.
> I guess it is much better than the situation before that, where you paid $5000+ and they also gave you an opioid addiction.
Having a condition that actually warrants strong opioids and not being able to get them at any price is definitely not an improvement.
The problem is fundamentally that we want to pretend doctors can always distinguish two people describing the same symptoms when one person actually has them and the other is trying to get drugs. The often can't, so you can either make it hard for people to get pain medications even if they need them, or you can make it easy for people to get them even if they don't. And between these the second one is unambiguously better, because the first one is the government screwing innocent people and the second one is guilty people screwing themselves.
> And between these the second one is unambiguously better, because the first one is the government screwing innocent people and the second one is guilty people screwing themselves.
Could not agree more. Depriving people with legitimate pain of opioids is IMHO legitimate torture. It's a bit of a variance on the trolley problem in that the doctor/government isn't causing the pain, but their inaction is prolonging it.
Brother (or sister), you were simply not trying hard enough. I live in a very clean, safe, expensively-policed county, and even I know where to buy fentanyl for much lower cost than a hospital. I would happily turn to that than take 20(!!!) advils in s single day.
Let's review the policy options in light of your suggestion:
1) We make it hard to lawfully acquire pain medications. You pay $$$ to see a doctor and you pay it even if they refuse you. If they do, you then have to pay $$ to get them from Stringer Bell, or start there to begin with if you didn't have $$$, and hope they're not cut with drain cleaner or unevenly mixed so that some days you get 100% corn starch and other days you get a fentanyl overdose.
2) We make it easy. Anyone can get them from Walmart. The people who need them pay the same $ they do for a bottle of Advil/Tylenol instead of paying $$ to murderers or $$$ to waste scarce medical resources that could have saved someone else's life. The bottle from Walmart always has a consistent amount of the drug in it and neither the dental patients nor the addicts get a surprise fentanyl overdose.
Whenever people here mention to my critique of US healthcare how its now mostly solved problem now, its 'good' to see the other side and reality. It certainly doesn't seem solved unless you have a million or two just laying around on the account, while mortgages and kids tuitions are paid. And I can easily imagine a long term condition or 10 which, if unlucky in terms of treatment cost coverage can wipe out that sum in a decade or two, for a single person.
Seriously, how can you guys consider this acceptable. I am not of faith but doesn't bible teach to be kind to your fellow men above all? One would expect more adherence to such basic moral rules in such conservative christian society.
I don’t know a single person in my life who thinks US healthcare is good, so that’s weird. And many my peers a have good jobs with good health insurance. Everyone I know has at least one bad story about insurance, if you’ve ever had more than really basic checkups.
The problem with the US system is that it doesn't know what it's trying to be.
If you did a socialist system then everything is "free" but possibly slow and expensive on the back end when the government isn't efficient.
If you did a libertarian system then everything is cheap but it's caveat emptor because nobody is stopping you from buying morphine for $10 from Amazon.
The US system isn't either one. It pretends to be a market sometimes but then has a bunch of rules to thwart competition. Doctors are required by law to do residency but the government limits the number of residency slots in response to lobbying from the AMA so there aren't enough doctors. "Certificate of need" laws explicitly prohibit new competitors for various services. Insurance is tied to employment to make it hard for individuals to shop around. Laws encourage, require or have the government provide "prescription drug coverage" to make patients price insensitive so drug companies can charge a huge premium for patenting a minor improvement or simple combination of existing drugs and have the patient will something which is marginally if at all better even if it's dramatically more expensive because they don't see the cost when the insurance/government is required to pay for it.
It's a big pile of corruption, because all that money is going to places. But then if you try to fix it, half the population insists on doing the first one and the other half is only willing to do the second one, and the industry capitalizes on this to prevent either one.
Maybe instead we should do both rather than neither. Have the government provide a threshold level of services, like emergency rooms and free clinics and anything more than that the local government wants to fund, and then have a minimally regulated private system that anyone can use if the government system doesn't satisfy them.
I think you're trying to apply ideology where it doesn't belong. Nobody on earth would advocate for such extensive spending to facilitate agreement on financing. It's extremely, extremely inefficient. (But it does produce jobs, which makes politicians super horny.)
The market also won't assist us, as we can't exactly compete future treatment costs against unknown illnesses.
Merely providing emergency rooms and "free clinics" will ensure that people only use these services.
A public option eliminating profit margin seems to at least be sane, and ideally would starve private funding from existence. Any remaining options would highlight deficiencies in the existing system.
A schumpeterian system, if you must slap an ideology on it.
> Merely providing emergency rooms and "free clinics" will ensure that people only use these services.
Emergency rooms operate by triage. If you're having a heart attack, you're going in right now. If your shoulder has been bothering you for six months, you might have to come back multiple days in a row and spend the whole day waiting before there is a slow enough day that you can be seen. There is then an obvious incentive to go pay a private physician to be seen immediately instead. Free clinics are similar: There are no appointments, it's first come first served, and then most people prefer to pay $100 to schedule an appointment rather than wasting an entire day waiting in a queue, but you still have that option for people with no money.
Emergency rooms are also a natural monopoly because in an actual emergency the primary consideration is which one is closest, which doesn't make for a competitive market. So it makes sense to have the government do that. Whereas non-emergency care (which is the large majority of medical expenses) would allow people to compare prices or make cost trade offs against distance or convenience etc., if we would actually expose people to pricing. For example by requiring price transparency and then having insurance pay the second-lowest price for that service within 100 miles of your location, but then letting you choose where you actually want to go and make up any difference yourself, or choose the lowest cost option instead of the second lowest and then put the difference in your HSA.
> A public option eliminating profit margin seems to at least be sane, and ideally would starve private funding from existence.
It's not clear how a government option that doesn't have taxpayer subsidies would do this any better than a private non-profit. There are many existing non-profit healthcare providers and they don't have meaningfully lower costs than for-profit ones.
The general problem is that "non-profits" and government-operated services still have money flowing through them and "profit" can be extracted in all manner of ways other than paying dividends to shareholders. The officers can just pay themselves high salaries, or whoever is in charge of the budget can take bribes/kickbacks to shovel money in the direction of the contractors or unions paying them off.
Meanwhile the nature of "profit" in a competitive market is largely misunderstood because of accounting differences. If a non-profit wants to buy an MRI machine, they have to take out a loan, and then pay back the loan with interest which they account for as an expense. A for-profit company might get the money to buy it by selling shares to investors, and then paying dividends to the shareholders instead of paying interest on a loan, which goes on the books as "profit" instead of interest expense. But you couldn't just replace them with a non-profit and then lower prices by the amount of "profit" they were making because then they also wouldn't have had private investment and you're back to needing the loan and paying the same money as interest to the bank.
The thing that requires providers to be efficient is competition, because then the ones wasting money or taking bribes have to cover the amount wasted/embezzled by charging more to customers and then the customers don't choose them because they have higher prices. But that's the thing the existing regulatory system goes out of its way to thwart.
Extra strength tylenol is 500mg a tablet, so 20 pills. Think most of the accidental ODs are due to people not realizing its included in other cold meds, and also being loopy from whatever illness they're trying to manage, and so end up forgetting when they last took the meds.
Its also a pretty popular choice for people trying to kill themselves, though, so I suspect a non-trival chunk of ODs in the statistics given in the article were intentional.
Taking too much acetaminophen is bad for you but 10g is 20 extra strength pills and that much isn't likely at all to kill you but damage your organs is quite possible. Reading this might make someone in a bad place think that much will do the job and it won't. Tylenol poisoning's most likely outcome is permanent organ damage and pain, don't try it.
I've been prescribed slightly more than 5g per day (2 x 650mg tablets every 6 hours) for pain after an operation jointly with ibuprofen, which is scarily close to the limits.
The .nl indicates the netherlands. Many people in the netherlands vent/joke about how the doctors here only ever tell you to take paracetamol and come back in two weeks if it's still a problem (recursive solution).
However the last time I went to my GP she scoffed at me taking the maximum and suggested I take literally double the maximum recommended dose 4-5 times a day which totaled I think 2.5x the daily maximum on the package. I am very much a "believer" in science and reasonable medical authority but this experience sowed the seeds of doubt, because from what I have always heard, that can actually kill you or cause permanent liver issues. I was also taking diclofenac simultaenously, and when I told her how many mg, she asked "where can you even buy such small doses, that's what I would give a small child" =/
My understanding is double the max dose of paracetamol is the LD50. Seems crazy for your GP to advocate for that. Published recommended dose is assuming average weight, so maybe if you're a very large person, the advice makes some sense, but wow.
They are common in France, but not in such packages: There are restrictions that prevent you from buying more than than 8g/day (theoretically at least, I don't believe they are strictly applied in practice).
They are widely sold at 1000 mg (1g) tablets in Europe, but in many countries they require doctor's prescription. There are also purchase limits to the number of pills you can buy at once.
As an American this is such a weird question to me. I purchase my ibuprofen and benadryl in bottles of anywhere from 400 to 1000 pills every few years.
Apparently a common source of problems is taking two different medications without realizing they both contain acetaminophen.
Suppose your arthritis is acting up, so you start taking Tylenol 8hr Arthritis Pain[1]. That's 2 tablets every 8 hours. They're extended-release with 650mg per tablet. A total of 3900 mg in 24 hours.
A few days later you get the flu, so you decide to add what seems like a completely different medication: Theraflu Flu Relief Max Strength[2]. It has a cough suppressant and an antihistamine. But each caplet also contains 500 mg of acetaminophen. It says to take 2 caplets every 6 hours, so you take 8 of them in 24 hours[3]. That's another 4000 mg.
Between the two, you're at 7900 mg.
Then you wake up in the morning and take both medications, but 30 minutes later you've forgotten you took them. You're not thinking straight because you're sick. So you accidentally take a second dose. That additional 2300 mg brings your total to 10200 mg.
[3] You weren't supposed to take 8 of them, though. If you'd read the label very carefully, you'd have seen it also says not to exceed 6 in a 24-hour period.
My personal rule is to only purchase over-the-counter meds with a single active ingredient. I'd rather separately take an antihistamine, expectorant and painkiller than a concoction where I have to read the whole label and do math while sick to separate the doses and timings.
There are some that are very hard to find as a single ingredient. Recently I was purchasing a medication for back pain, I had a choice as to which other ingredient I wanted, but I didn't have the choice of none. I picked the combined ingredient I don't like to take, because I wouldn't be adding it on top.
I did toss on the other option, stand alone, at one point so I could get some sleep.
It left the medication I was more comfortable taking as an add-on option if things got bad enough. (This particular medication has much lower risk of overdose, so if I got stupid and took it again there would be no significant additional risk.)
It's ironic, but taking the combined medication with a known higher risk of its own was better than taking the lower risk medication.
One was controlled, higher risk, taken at specific times, while the other was taken in addition, on demand, as required.
Specifically this is one reason they’ll sell you cocodemol or Vicodin but not codeine or hydrocodone directly — if you take enough to get a codeine high, you’ll have taken a toxic amount of paracetamol/acetaminophen, so they assume you won’t.
I didn't until I had a bulging lower back disc pressing on my sciatic nerve. My leg felt like it was constantly on fire no matter what position I put myself in. In the past I've torn my ACL and had surgery to reconstruct and that pain was like stubbing my toe compared to the back pain. I understood how people become addicted to pain meds after my back situation.
Totally get it, I too only understood it "theoretically" till I had a (fairly minor!) dental operation.
... Suddenly I'm maintaining a continuous note of when I'm taking which medicine to avoid crossing safe limits (which I anyway was crossing most days).
I was only told to take 2 paracetamols a day (bullshit dose, I'd be waking up from the pain even with more pain meds).
"Diclofenac for rare use" - well, if nothing else is touching the pain, is it an emergency?
Eventually after forever I was able to transition to Ibuprofen + paracetamol. And I already have a health condition which is heavy on my kidneys... pain management can be absolutely crazy.
Pain management can be crazy but in your case it sounds like they simply didn't prescribe the appropriate medication presumably due to the anti opiate hysteria that has taken hold.
While that's quite possibly true, I forgot to mention that I'm not in the US but India. I was conscious the whole time, with only local anesthesia. Also the dentist in question is actually our "family" dentist, and he's a pretty knowledgeable/skillful guy (easily more knowledgeable than many GPs on health matters of the body).
Fun fact, you can totally get them to pause the procedure without saying a word. All you have to do is end up in a lot of pain, have your heart rate skyrocket like anything, and get everyone in the OT very concerned ;)
I had severe nerve pain due to a herniated disc. While awaiting a surgery, I was prescribed an opioid (Tramadol) but it didn't seem to help much at all. Acetaminophen actually worked better than the opioid for me...
This can easily happen over the course of 24 hours if you're in "fuck me I'll do anything to make it stop" levels of pain. I've taken more than 20 ibuprofens in a day a few times in my life, which, while not medically advised, did not kill me. I actually had no idea acetaminophen was so dangerous.
Just in case, ibuprophen does not work well for pain relief [at lest for some kind of pain]. Paracetamol [acetaminophen] usually is much better against pain.
And paracetamol + ibuprophen can help with strong pain for which neither paracetamol or ibuprophen work at normal doses.
Not really. Both address different sources of pain, and do so using different processes.
Ibuprofen is a Nonsteroidal Anti-inflammatory Drug (NSAID) that reduces pain and inflammation, while acetaminophen does not. (Acetaminophen is believed to act mainly in the brain rather than at the site of injury).
Ibuprofen- Fundamentally, if the pain is caused by inflammation, reducing the immune systems response to it can reduce pain, but if the pain is more acute it won't make a dent.
With acetaminophen, taking more isn't a solution in most cases, you need another method to reduce the pain further if it doesn't achieve its goal.
(That's why it's combined with things like codeine, which affects the brain in a different way for an additive effect)
> you need another method to reduce the pain further
I don’t know about “most cases” but often you don’t want to reduce the pain _further_, you want to reduce the pain _again_. (Having an alternative definitely helps in the meantime.)
Buy a pack of 20x500mg (just checked, common size in Germany), take 2-3 every half hour for a while.
Sure, that's extreme. But if you're unaware of the risks, you feel sick, and you believe it's helping you.
I mean, people aren't killing themselves in masses with it, but it happens every now and then. Easily imaginable that one in a few million people will have enough tendency to take more pills and is unaware of the overdose danger.
You can still buy 100 packs, they are just behind the counter at chemists. TBH it's a rather stupid restriction - do they think people only ever own 1 packet of paracetamol at a time? In my household we have at least half a dozen, including a 100-pack from Oz and a 500-pack from America.
Oh right - that's probably what we did, buy a big pack from behind the counter.
I don't think you can even do that in the UK.
Yeah we usually have a few packs hanging around, and I get the 'it seems stupid' thing, but sometimes just adding a tiny bit of friction when someone's trying to kill themselves might save a life. I dunno, I hope that's shown in the evidence anyway. Otherwise it's just pointless like the whole pseudoephedrine song and dance, which has inconvenienced anyone looking for a decongestant while doing sweet FA to the availability of meth.
> Oh right - that's probably what we did, buy a big pack from behind the counter.
No, when you visited they were still on the shelf. They only put them behind the counter in 2025.
> sometimes just adding a tiny bit of friction when someone's trying to kill themselves might save a life
I'm philosophically not for making suicide harder. If someone wants to die, that's their right. And practically, while you might be able to show a stat-sig decrease in paracetamol poisoning, I'd expect the suicides to largely just move to other methods.
The point is that many don't really want to. Those that actually want to can buy two boxes from two shops or ask the pharmacist for the big pack from behind the counter.
This just adds a tiny amount of friction to impulsive attempts, which may be a classic cry for help or just someone in the depths of some sort of mental health episode. Such folks may think better of it the next day and a very small amount of inconvenience will put them off. I think suicide is serious enough that you should probably mean it, and societally saying 'think twice about this' is a good thing.
On the idea that it just shift deaths, as your sibling poster points out (from the UK) -
"in the 11 years following the legislation there were an estimated 765 fewer suicide and open verdict deaths from paracetamol poisoning, which represented a reduction of 43% [...] This reduction was largely unaltered after controlling for a downward trend in deaths involving other methods of poisoning and also suicides by all methods."
So it looks like this tiny, tiny barrier does actually deter people. And that definitely points to them not really being sold on it in any rational way.
I just don't buy the paternalism. People have free will, if they want to do something they would regret later, it's still their right.
That quote doesn't say what you think it means. It's not talking at all about whether suicides shifted to other methods; it only says that there was a secular decline in poisonings (-32%) and suicides in general (-10%) during the study, so they have to also discount some of the raw 48% drop in paracetamol as being part of that broader trend and not due to the treatment. They come to the 43% number only with a generous assumption that had the law not gone into effect, there would have been an increasing trend in deaths from paracetamol poisoning, which seems wrong to me. The more obvious way to derive the prior would be to look at non-paracetamol poisonings and expect the same trend, in which case the effect might be something like -24%.
Anyhow, it's still perfectly possible that the people who were deterred from paracetamol poisoning committed suicide some other way; the data in that paper says nothing about it.
> People have free will, if they want to do something they would regret later, it's still their right.
Then this minor frictional measure is the very least of your worries. For a start, any given pharmacy has an entire pharmacopoea of compounds that people are kept away from for their own good. Not to mention liquor licensing rules making landlords cut folks off at a bar if visibly drunk etc. And guard rails to stop people climbing to high places. And ... preventing people from doing stupid shit in the moment is everywhere in our societies.
There are a heck of a lot of things I'd put higher up my list of concerns than "may have to visit two shops if wanting to kill myself"
Paraphrasing from [0], after September 1998 when the restriction was introduced, "The annual number of deaths from paracetamol poisoning decreased by 21% [...] the number from salicylates decreased by 48% [...] Liver transplant rates after paracetamol poisoning decreased by 66% [...] The rate of non-fatal self poisoning with paracetamol in any form decreased by 11%"
See also [1]: "in the 11 years following the legislation there were an estimated 765 fewer suicide and open verdict deaths from paracetamol poisoning, which represented a reduction of 43% [...] This reduction was largely unaltered after controlling for a downward trend in deaths involving other methods of poisoning and also suicides by all methods."
Yes, and you can still die in a car crash if you're wearing your seatbelt, and wearing a helmet on your motorcycle won't save you from a head-on with a truck, and you can still drown in a pool with a lifeguard, and you can still die in a burning building with smoke detectors.
Harm reduction is about shifting probability distributions, not guaranteeing outcomes. Kids can still get into pill bottles with childproof medication caps, but accidental ingestion of aspirin by children reduced by 40-55% after they were mandated. [0]
No. Ethanol and tylenol compete for CYP2E1 that produces toxic NAPQI, so no, acute alcohol intoxication has a protective effect at least where it comes to tylenol toxicity.
Alcohol and Acetominophen/paracetamol should not be mixed.
When alcohol enters the picture, it increases the activity of CYP2E1, so the body produces more of the NAPQI toxin. Alcohol also decreases glutathione production, the body’s natural defense mechanism, meaning NAPQI is more likely to build up in the liver in dangerous concentrations.
There is a danger in chronic abuse resulting in upregulation. Mixing the two at once is no problem for the liver, which is also why patient information leaflets for paracetamol do not contain a warning to avoid alcohol, only about chronic alcohol abuse.
Your crappy source is vague in what consumption pattern constitutes a risk and actually cites a better source that supports the idea that acute alcohol consumption reduces paracetamol toxicity. https://www.biorxiv.org/content/10.1101/2020.07.07.191916v1....
That's a mathematical model, but this relationship between the two is what I was taught in medical school and it is still supported by the science. There's plenty of other sources, I just picked that one because your article cites it. Just search for "paracetamol ethanol" on Google Scholar.
Am I the only one who does that?
(EDIT: Same thing on Finder. cmd+C cmd+Del cmd+V)
Anyway, I love the design aesthetic of the site, and when people question existing paradigms. Will definitely be checking Ishmael out.